Speaking and Listening: The Year of Multi-dimensionality

My roles as a freelance writer, marketer and strategist often overlap with my civic responsibilities, my community connections and my ever-growing list of friends. So people don’t know what I do, or necessarily why I do it.

I’m a multidimensional person and my goal this year is to try to embrace that. My personal interests and my work and my commitment to my community all overlap, which means that I learn useful things for my career even when I’m not paying or being paid, and I learn relevant information for my personal life from things that are meant to be professionally focused. It’s a wonderful thing to be able to integrate all of these components.

In the past year, I’ve spoken at these events professionally, as a publicity professional, journalist and career mentor:

July 2018 and 2019 The Sorensen Institute for Political Leadership High School Leaders Program: I presented about Building Your Professional Presence, including resume writing, job interviews, career planning and networking.

March 2018 and 2019 The Sorensen Institute for Political Leadership Candidate Training Program: I presented about Media Landscape as it related to political campaigns, including media relations and planning, pitching, being interviewed and how to handle different types of media outlets. In addition, I presented on Crisis Communications management.

January 2018 Greater Williamsburg Chamber and Tourism Alliance: I shared Getting Positive Press for small business owners, from the my professional experience but also as the editor of The Local Scoop magazine.

These are personal commitments for me, making the world better by talking about things that matter to us:

January-February 2019 Our Whole Lives Co-facilitator for a 7 week discussion group and class for adults 25-55 about adult sexuality.

May 2019 short talk “From the Heart: The Risks of Motherhood”

July 2019 sermon The Courage to Show Up

These are events I’ve attended, with the majority being in my sweet spot of health and civic life:

  • Cleveland Clinic Patient Experience Conference: the national health care leader in incorporating empathy and high touch patient experience into high tech health care

  • Virginia Hospital and Healthcare Association Summit: discussions about health care trends specific to Virginia and its health care providers

  • Our Whole Lives training: intensive three day training on facilitation and content best practices

  • Patient-Centered Outcomes Research Institute: annual conference for this funder of innovative, responsive health care research

  • Virginia Library Association Conference: librarians from all over the state share best practices, listen to experts and authors and share tips on advocacy. I’m the Chair of the Board of Trustees for the exceptional Williamsburg Regional Library.

  • Virginia Chamber Economic Summit: business leaders come together to listen to government officials, economists and innovators on what’s next for Virginia

  • Virginia Chamber Healthcare Conference: discussions about health care trends specific to Virginia, mainly from economic and employer perspectives

  • World Health Congress: international conference covering myriad health care topics (my cousin JoEllen was speaking!)

  • MASHSMD Annual Conference: the Mid-Atlantic arm of the American Hospital Association’s Society for Healthcare Strategy, Marketing and Development (I’m on the board.)

  • Network NoVA Women’s Summit: Progressive Virginia Women talking about upcoming 2019 elections, issues such as child care, gerrymandering, voting access and community advocacy…and much more

  • American Evolution: Forum on Representative Democracy: In commemoration of the 400th anniversary of the first representative government assembly in the New World at Jamestown, this event covered the challenges to representative democracy including technology, nationalism, media, partisanship, apathy and more.

I’m very passionate about health communications, leadership and civic engagement. We should all have a voice in things that matter to us, and accurate information to make decisions about our lives.

If you’d like me to speak at your event or training or attend a conference and report back on it, please let me know.

Doc, Come Quick!

Besides reading about modern health care innovation, I love to read historical and fantasy fiction and watch historical dramas. One things I've noticed is this: health care skills have always been valued. I expect this will continue. 

Take the case of Claire Fraser, heroine of the Outlander series. She's a time travelling nurse who goes from World War II to 1743, and although she lands in hot water almost immediately, she is able to win the trust of her captors with her medical skills. Not only is she an amateur botanist, she knows about...germs! Which puts her ahead of her sudden contemporaries. She's got excellent diagnostic skills, having read and seen all manner of illness in her time. Ms. Fraser is experienced with sutures, tinctures and identifying whether a rash is a serious or fleeting illness. Her skills amaze others and she saves lives and wins the trust of many who help her find her way. (Of course, much of the delight of her skills for readers is that in 1743 everyone thinks she's a witch...but it's just modern medicine transported 200 years in the past!)  

Same with Doc Cochran, the only medical professional in Deadwood -- based on a true town in South Dakota. He's a grump Gus, and he should be because his patients are nearly all in bad shape. They've been injured in a mine, shot in a gunfight or are infected with a veneral disease. The show is all about this violent town's struggle for gold and independence, but Doc is able to disagree or raise a holler without any consequences...because everyone knows they soon may need his services. No matter how vicious relations get, the Doc is able to treat people, insist on better public conditions and even defy some of the more powerful people to do what he needs to do, because he has the medical skils that anyone may need imminently.  

I note these two characters, but there are many more, on apocalypse shows like The Walking Dead or CW's Hart of Dixie or BBC's Call the Midwife that make the same point. People will always be in need of health care, at some point. That makes these skills invaluable -- and I would like to note, we need to prioritize public first aid response training, professional health care education AND preventing burnout for our health care professionals, too. It's part of the human condition, and today we know that more than ever -- so we should be ensuring that we recognize this value. 

The More Things Change...

I found an old photocopy of a book I read in college for my journalism class called "Breaking the News" and I'd copied the section health care reform. 

Here are some quotes that could have been written today, rather than in 1998:

"...the market for medical care did not operate in the same way as markets for imported cars, or houses, or anything else...the health care market differed from other markets in that people don't even do the paying themselves, at least not at the time they get the care. I n a perfect market situation, the purchaser will have free choice among many alternatives, he will have full knowledge about the selections and he will have an incentive to economize. In the medical market the customer often has non of those things...the patient is often the object of this process rather than a participant in it."

Sounds the same, right? Despite attempts to make health care more transparent, people largely make their decisions based on "is this covered by my insurance?" or more commonly, "I hope this is covered by my insurance...I guess we'll find out."

"Businesses were in a panic about medical expenses, and so were any public officials responsible for a budget. The United States spent twice as large a share of its national income on medical care as the average for other developed nations. The money bought the world's most advanced and high-tech treatment for certain maladies but it also left the US with a higher infant-mortality rate and a lower life expectancy than in other advanced societies."

Panic, check. Highest infant-mortality rate, check. Lower life expectancy, check. And we are still spending WAY more than other countries on health care: OECD data shows the U.S. spent 17.1 percent of its GDP on health care in 2013, 50 percent more than France and almost double the United Kingdom's spending. 

"The strongest argument for single payer is, strangely, that it would be anti-bureaucratic. The great administrative nightmare in American medicine is the need to keep track of dozens of reimbursement forms from dozens of insurance companies, each with its own rules about payment rates and authorized courses of care."

Bureaucratic nightmare? Yep. Possibly we've gone further in our agreement that routing health care through employers is a difficult way to cover stay-at-home parents, entrepreneurs and small business owners. So, as we look at the future of American health care...what can we expect? Surely, change. But what kind? Time will tell. 

Why Regionalism Will ALWAYS Matter

I went to a economic summit in Virginia recently...and there was quite a buzz from the people sitting around me. It wasn't about the economic data. It was about the speaker, who admitted he was from California, repeatedly calling a city in western Virginia "Stawn-ten."

Well, we are very particular here in the Commonwealth about the way things are pronounced (also, about being a Commonwealth!) Especially our inherited English city names. It's "Stan-ten." (Yes, we know there's a U in it.) It flags you immediately as an outsider, (or an unprepared speaker.)

My point? No matter how globalized we get -- there are some local things that show you are part of the community, that you are familiar, that you took the time to get to know us. I doubt this will ever change. Like the recent holiday gifts: I got Malley's Chocolates from Cleveland, and my husband got Esther Price Chocolates from Dayton. Are these Ohio candies all that different? Probably not, but our childhood memories are, and that goes directly to the brand.

It's the same with any marketing -- it needs to take into account the uniqueness of the people who live in a regional, and respect it. There is no one size fits all, and I think it's human nature to want to distinguish ourselves. We want to know that we are not like everyone else, personally and as a community. It's why local breweries are doing so well, why farmers markets are popping up everywhere and artisan goods are getting a premium.

Hospitals, once stalwart icons of the community, would do well to remember their roots as well. The trend toward larger system franchises offers more access and more resources, but health care is deeply personal, and that should always be in the forefront.    

Here, Take This!

For months, I've been carrying around a stack of papers in my planner. It's about four pages, stapled. It's my son's occupational therapy evaluation report. 

I'm not carrying it around because I need it for any reason. I'm carrying it around because of a highly annoying, yet highly prevalent health care issue: electronic medical records.

My son's therapy office emailed me the report. Great. I've used that method to share it with the school nurse and teachers. But I called my pediatrician's office and asked them how I could share that with them, and they said they could not accept it via email. 

But I could fax it. Ha! (I haven't used a fax machine in years. In fact, my office doesn't have one.)  

More importantly, it makes no sense to take electronic information, print it on to paper and then send it over phone lines to be filed and transcribed electronically on the other end. But this is evidence of our "inherited architecture" problems in health care. We can't all get on the same page.

Some people adopted EMRs early, even designing their own customized portals. Problems with different systems (both health and IT ones) led to sharing problems. With the migration of most big health systems to EPIC, maybe this will be smoother. 

But...the issues I've had are with the little guys. The independent therapy practice is not going to go EPIC. Just like my OB practice just faxed all my paper records to the hospital and they PDF'd them but couldn't search them. All the paperwork for kids' health at schools is on paper back and forth between home and school, then put in the computer there. These little glitches mean that there are redundancies and  gaps. 

We are stuck in the era of bumpy roads with EMRs -- they should be making things go faster, smoother and more directly to the right places. But, sometimes it rains and we're stuck in the mud. I finally delivered the paperwork to the pediatrician on Friday. I held it in my hand the whole time so I wouldn't forget. I would have been so mad if I left without giving it to them. But I also would have been so happy to have sent it to them via email in April! 

Advice for Entrepreneurs: Believe You Can, Make a Plan, Be Aggressively Positive

I just found some notes from a great speech from Dr. Angeline Godwin, President of Patrick Henry Community College about teaching entrepreneurship (which is hard to do!)

Here's 5 questions to ask yourself, and a few comments from me on how I started down the road to Entrepreneurville:

1. The Bird in the Hand: What do you have right now? When I started my business, I had very few concrete things. Luckily, I wasn't selling goods, I was selling my brain, my time and my experience. I had to get a new computer, business cards and a website -- and get out there! I had connections but I need projects. I had some freelance clients, but they weren't steady. I did not have any previous business experience, but I'd worked mainly for small, growing companies which taught me a few things (mostly, what to avoid!)

2. The Affordable Loss: What are you willing to lose? I was in a very stressful work situation that required a lot of hours and freelancing seemed to be a great option. I wish I could have had a better, more stepped transition but unfortunately it didn't work out that way. So, I entered entrepreneurship by jumping into the great unknown and growing wings on the way down. Depending on what day it was, I was confident or disconsolate. Some of the uncertainty was balanced by less stress and more freedom -- but it's also incredibly hard to shake the feeling that you could ALWAYS be doing more.  

3. The Crazy Quilt: Who do you know? (who isn't like you...) I made lots of lists. People i knew locally, people from previous jobs in Cleveland, people I'd met at conferences and through work over the years. It's amazing how many people you collect -- and once I was focused on health care, it was interesting to see who I knew who might hire me that i had no work connection to. It's really a testament to ensuring you have a good all-around reputation. Many of my clients have come to me in unusual ways, through friends and colleagues and I appreciate that tremendously.

4. Lemon to Lemonade: What will you do when, not if, something goes wrong? I spent a lot of time worrying about things going wrong, even when they were going right. Being an entrepreneur will make you hyper-vigilant. It's important to have a Plan B and a Plan Z (as LinkedIn founder Reid Hoffman coined) as well as just plain faith in yourself. If you are good at what you do, if you are reliable and deliver as promised, if you can adapt to changing situations -- why can't you count on that in the future? 

5. Piloting the Plane: What do you control? Well, you can only control so much, and worrying will make you nuts. So, that's what insurance is for. I got some good advice in the beginning about setting aside half of every paycheck, and to get business insurance -- not just for liability, but for errors and omissions and other business issues that might be out of your control. You can create processes and set up policies as you learn, too, so you don't make the same mistakes twice. 

Entrepreneurship isn't for sissies. But it can be tremendously rewarding and the freedom can make you never want to work for anyone else again. I love what I do -- and I love that I have created my business to serve my clients in a way that works for them, too. Dr. Godwin also said "Be Aggressively Positive" and I think that's great advice. Believe you can do it. Make a plan to do it, and get to it! 

Food IS Social...We Should Admit that When Trying to Change

Right now I've got three streams of work projects where food is part of the conversation. Food allergies, obesity and oral health -- all of which relate to what you can eat, what you should eat and what you cannot eat. I think in the health care field, we tend to overlook how hard it is to change social food patterns. 

Here's an example -- in an article called Social Consequences of Food Allergy, Catharine Alvarez mentions a recent study in Pediatrics about Bullying of Kids with Food Allergy.  She mentions that she was surprised by people's resistance to accommodating her kids' food allergy restrictions.  What it seems to come down to is deep social mores that if you reject food that's offered to you, you are rejecting the person offering it. There is symbolic social function in shared meals, and the avoidance of sharing food, even because of a serious medical condition is not easily accepted. 

For obesity, there are similar issues. Control of one's diet, although necessary, can be difficult because the reality is that we don't eat in isolation. We eat with our families, we eat at work, we go to restaurants together, we share celebratory meals and meals at community events. It's never a solo event, and if it must be, it makes it difficult to sustain. The person unpacking their individual containers during the lunch hour is often seen as sad, while the people who join in the Friday lunch bunch are seen as good company. 

In a meeting with a speech pathologist this week, she mentioned how many of her patients have issues with swallowing -- and how being restricted to soft foods like applesauce and mashed potatoes is demoralizing for patients. They want to eat. They have favorite foods, comfort foods and they want to eat with their peers...whether they are 70 or 7. 

I don't think there's any question that health care professionals know that food matters, but we often look at the calories, the protein or the processing instead of the environment.  Food is social, and addressing who we eat with may be as important as what we eat in changing behaviors.  

Faxes, Paperwork and Our Tangled Mess of a Health Care System

Often, the best illustrations are personal. Here's the stats on my spring break health care administration for my sons:

1 ENT appointment                                 9 pages of paperwork

1 Occupational Therapy evaluation        4 pages of paperwork

3 dental appointments                           6 pages of paperwork

I filled it all out, with compliments from the front desk staff (I am a professional, after all.) But, I don't have great handwriting, and what are they going to do with it after I hand the clipboard back to them? They are going to type it in to their computers. Why can't I just type it into an online form? And, the dentist isn't new, it was just time for an update -- why couldn't they have read it to me and I confirm all the information, which hasn't changed one bit?

I know there's a lot of change in health care right now, but this is one of those process improvement issues that has long been adopted in other fields. In addition, the ENT's fax machine wasn't working so I went the pharmacy 3 times to pick up a medication that should have had a confirmed refill. Why is anyone faxing anything? 

I'm sure this has something to do with privacy laws, and security of information, and of course that's important. But I suspect a large part of it is that no one has pressed for this kind of improvement yet, they are too busy with other concerns. While I'm sympathetic to that, I feel it's more evidence for what Walter Cronkite said "It's neither healthy, nor caring, nor a system." A healthy system contains up-to-date health information, a caring system makes it easy for people to share their information and a system means there's an efficient process to do so. 

I'm optimistic about the requirement of electronic medical records, even though there's lots of grumbling about them. I think they can and will help patients and their care providers do better. First, let's get off the paper.  

I Thought They Could Fix Anything....I Was Wrong.

A few weeks ago, I saw a great patient video discussing a woman in the MidWest talking about her snowmobile accident and she gave great feedback for the staff. But she also said "I knew I was hurt but I thought, 'it's 2015, I thought they could fix anything.'" She lost two of her fingers permanently. During the interview, she mostly kept her right hand over the left hand with the missing fingers. She talked about the confusion when her doctor told her that the fingers were beyond saving. But her comment on the perception of most people that hospitals in America can fix anything has stuck with me. We do have amazing trauma teams. We have technology that diagnosis quickly, stabilizes and can mimic functions that the body can't manage on its own. We have blood transfusions and intense surgical techniques. 

But we still can't do it all. When I gave a presentation recently on infectious diseases, I reiterated this to the audience -- avoiding getting sick is still really important. We can kill bacterial infections with antibiotics, but it's getting harder. We can't kill viruses with antibiotics though, and there are few anti-virals available. We have to be smart and avoid injury and disease -- and be grateful for the advances in medicine should we ever need them.  


After giving a presentation this week on infectious diseases and deciphering health information, plus attending an excellent SHSMD session on the handling of the Ebola panic, I have a few thoughts. 

1. Even if all of us who work in the medical field think that people should know something, it's best to go back to the basics. Like the super-basic foundations of science -- for example, that a virus and a bacteria are different things but both can make us sick. Or, that one study does not science make!

2. Internal communication is ultra-important in a crisis. It's not enough to reassure the public. You must communicate to your staff, your board members, your volunteers and anyone working in your hospital. Because your credibility goes in the toilet when you say "We're prepared" but the reporter interviewing nurses on the loading dock hears "We've had no training on this."

3, Fear is a strong motivator, even if people know they shouldn't be afraid. They are, and they want to play it safe. I heard from someone who was thinking of firing her nanny because the nanny's mom was a nurse. It sounds like an overreaction now, but if you recall earlier this year, we were a nation on the edge of our seats as to whether we'd have an outbreak or not.

4. Communication takes time. It can be laborious when you want to be doing (let's go!!!) but it will save you time in the long run. Return people's calls (especially reporters!) even if you don't have anything new to share. Tell your employees what to expect. I agree with Doug Levy (formerly of Columbia University Health System) who said "Communication can't solve everything but it puts you in the best position to catch flaws in your plan." 

Infectious diseases are a tough topic, but one that we will continually revisit. They won't go away -- but we can educate and we can prepare. Oh, and we can communicate! 

SHSMD 2015

It's great to be here at the American Hospital Association conference for the Society for Healthcare Strategy and Market Development. While these are "my people" since I work mainly in hospital and health system marketing, I've met some people working in interesting niches. Like those people who just work in planning and strategy -- like all day, every day. I love that these roles exist. I think one of the biggest gaps in corporate health care right now it that everyone is trying to be good at everything -- and it's not only a huge waste of time and money, it's drains energy from what a truly focused organization could be achieving. Values matter, and you need to unearth a ton of extra stuff to get down to that bedrock of what you value and your strengths.

Another big theme I'm seeing is value over volume. The keynote yesterday mentioned this huge industry shift, and it's part of the reason there's so much churn in health care right now. How can we turn a group of care providers, facilities, systems, support staff and practices the metaphorical size of an aircraft carrier? How can we turn back time to when patients were eating healthy and exercising, before they started pairing soda with every SuperSized meal, before their blood pressure rose and their waistlines ballooned. 

There's a lot happening and it's exciting to be in the middle of discussing it, in depth -- that's the value of breaking from the everyday work to sort out what we know and add to what we don't. 

Sometimes Health Communications is...calling 911

Coming from a family of health care providers (I was discussing cardiac catheters in depth with my cousin on vacation) means that i often feel that my non-clinical experience is not as practical. Sure, I know CPR and first aid, but how am I an emergency?

Well, yesterday at work I got to find out. A woman coming into our building fell on the sidewalk and was gushing blood from her head and face. While my office mates found the first aid kit and wet wipes, I called 911. I was clear and direct, giving my assessment of the severity of situation. 

Because vasovagal syncope (see, I know big medical words!) runs in my family, dealing with bleeding people is on the reasons that I did not pursue a clinical career. So I focus on what I CAN do, which in this case was to call in the professionals as quickly as possible, armed with the most information I could provide. 

I realized later that this is "health communications," what I proclaim that I'm a specialist at -- and it's part of the whole health care experience. Not everyone can bandage the wounds, sometimes they just facilitate getting the person who can to the person who needs it.  I'll call that a win. 

"I think the doctor said..."

I just read an article in the Journal of Patient Experience with this statistic in it: 

"Miscommunication between physicians and patients is the most common cause of medical errors and is responsible for more than 60 percent of sentinel events that lead to increased mortality or injury among hospital patients." 

Think about that. More than half of errors are caused by two people trying to communicate but failing to do so. And, I'm sure you've been there. I know I have. The doctor says to do something, in a regular tone of voice, and I'm not sure if it's a suggestion or an imperative statement. Or the doctor says "make sure to..." and I'm so overwhelmed by trying to remember it that I get confused. If you aren't in the habit of repeating it or writing it down, you may very well forget it. 

The journal article was about AIDET training (created by the Studer Group) for physicians. It seems simple but patients know that many of these steps are missed. 

A: Acknowledge (address each person in the room)

I: Introduce yourself  (and your role and your specialty)

D: Duration (how long will you be in the room, is there a procedure happening?)

E: Explanation (what's the treatment? what's the diagnosis?)

T: Thank You (appreciation for their time, questions, etc.)

In a hospital environment, these common courtesies can easily be overlooked, because everyone is in a rush. But it matters. It matters to patients, and it may prevent medical errors and miscommunication. That seems like a great reason to take the time to do it. 

Friendliest Conference Ever? Of course -- it was about empathy!

Patient experience is close to my heart, because it's a buzzword, but it matters. I'm glad people are paying attention to how the patient views the medical experience, and not just that care is delivered effectively. 

The Cleveland Clinic's Patient Experience Summit "combines empathy and innovation," and this year's theme was Empathy Amplified.  Each presenter selected music to come on stage to and it was fun to see what they selected, from U2's "It's a Beautiful Day" to "It's the End of the World as We Know It" by R.E.M.  This set the tone for a great conference, and even though there were more than 2,000 people there, by the fourth day, I had lots of friends!

Innovation needs to be about pressing where things are bit uncomfortable and the general sessions delivered a lot of surprises. 

1. The Ostrich Index. "We ask people to operate in a self-actualized peak experience and they know they should... but they just can’t prioritize that right now. It’s not about cost, access or transportation. It may be money issues, a lack of support, conflict, stress, debt, no time to exercise, substance use, sad, not sleeping, no spiritual outlet, no sex life or caregiving demands. Stress is real." -Alexandra Drane, Eliza and Seduce Health

2. Toxic Doctors = Darth Vader. "Silence is a moral issue. Silence kills. It creates a culture that undermines safety. Darth Vaders create a toxic environment. Staff can’t breathe. This allows incompetence, shortcuts and disrespect. Inaction is an immoral act." -Dr. Wyatt, Joint Commission

3. Machines Make Fewer Mistakes. "A combination of forces approach -- care anywhere and care in teams are already hear. Care by machines? Care by large data sets? On their way. Robots don't have to be perfect, they just have to make less mistakes than humans."

Given our Darth Vaders, maybe machines would be better? I love the honesty that we may not be providing what patients (who are human) really need. They repeatedly say they want to understand what's happening to them, be involved in the decision-making process and have people be nice to them (because they are very scared.) Seems reasonable, but the giant knotted system of health care is hard to turn around. This summit was a great step in the right direction and I applaud all involved.